Application for Senior Administrative Law Judge & Geographic Preference Statement for Senior Administrative Law Judge

Forms and Documents

Document Name	Status
Form OPM 1655A Geographic Preference Statement for Senior Administrative Law Judge Applicant Form and Instruction	Modified
Form OPM 1655 Application for Senior Administrative Law Judge Form and Instruction	Modified
3206-0248 30 Day.pdf Supplementary Document	2021-08-23
Supporting Statement A -3206-0248 - 6-21-21.pdf Supporting Statement A	2021-06-24
60 day 0248.pdf Supplementary Document	2021-06-16
6 - Legal Citation(s).pdf Supplementary Document	2021-06-16

IC Document Collections

IC ID	Document Title	Status
182393	Geographic Preference Statement for Senior Administrative Law Judge Applicant Form and Instruction	Modified
182362	Application for Senior Administrative Law Judge Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0248	ICR Reference No: 202106-3206-001
Status: Received in OIRA	Previous ICR Reference No: 201805-3206-004
Agency/Subagency: OPM	Agency Tracking No:
Title: Application for Senior Administrative Law Judge & Geographic Preference Statement for Senior Administrative Law Judge
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/09/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	09/30/2021
Responses	350	350
Time Burden (Hours)	161	161
Cost Burden (Dollars)	7,899	0

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Abstract: OPM 1655 and OPM 1655A will be used by retired Administrative Law Judges seeking reemployment to complete hearings in accordance with the Administrative Procedures Act of 1946. These forms streamline the application process by providing all needed information on 2 forms. The forms have changed to only to include updated regional selections.

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Authorizing Statute(s): US Code: 5 USC 3323(b)
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 26966	05/18/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 47168	08/23/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Application for Senior Administrative Law Judge	OPM 1655	Application for Senior Administrative Law Judge
Geographic Preference Statement for Senior Administrative Law Judge Applicant	OPM 1655A	Geographic Peference Statement for Senior Adminstrative Law Judge Applicant

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	350	350	0	0	0	0
Annual Time Burden (Hours)	161	161	0	0	0	0
Annual Cost Burden (Dollars)	7,899	0	0	7,899	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $5,794

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/09/2021

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